Methods and systems for delivering an implant

ABSTRACT

A system for delivering an implant including a handle, a trigger, and an actuation assembly. The actuation assembly can be configured to displace the outer tubular member in the proximal direction a distance (d) relative to the handle and to separately move the inner shaft member distally a distance (x) relative to the handle upon deployment of the trigger from a first position to a second position, and move the inner shaft member proximally a distance (y) relative to the handle with no displacement of the outer tubular member upon return of the trigger from the second position to the first position.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims priority to U.S. Provisional ApplicationNo. 62/075,059, filed on Nov. 4, 2014, the entire contents of which isincorporated herein by reference.

BACKGROUND

1. Field of Disclosed Subject Matter

The disclosed subject matter is directed to systems and methods fordelivering one or more medical devices, for example an implant, and morespecifically, a braided implant. The braided implant, for example astent or scaffold, can be disposed within a delivery system having anactuation assembly configured to deliver the braided implant using areciprocating motion.

2. Description of Related Art

Conventional self-expanding stent delivery systems can include a handlehousing portion and an elongated shaft, wherein the stent is disposedwithin a delivery portion at the distal end of the shaft. To deploy thestent, an outer sheath is retracted relative to the stent, whereby thestent is released from its delivery configuration. In certain systems,an inner member having a pushing mechanism disposed proximate to itsdistal end can be used to push the stent from the outer sheath, whilethe outer sheath is retracted.

However, there remains a need for a system and method for moreaccurately delivering an implant using a relatively simple motion andease of use.

SUMMARY

The purpose and advantages of the disclosed subject matter will be setforth in and apparent from the description that follows, as well as willbe learned by practice of the disclosed subject matter. Additionaladvantages of the disclosed subject matter will be realized and attainedby the methods and systems particularly pointed out in the writtendescription and claims hereof, as well as from the appended drawings.

To achieve these and other advantages and in accordance with the purposeof the disclosed subject matter, as embodied and broadly described, thedisclosed subject matter is directed to systems and methods fordelivering an implant. For example, an implant can be disposed within adistal end portion of an outer tubular member of the system andpositioned to be engaged by a distal end portion of an inner shaftmember of the system when the inner shaft member is moved distallyrelative to the outer tubular member. The inner shaft member can bedisposed within the outer tubular member and movable distally andproximally relative to the outer tubular member. The system fordelivering an implant can include a handle, a trigger, operativelycoupled to the handle, and an actuation assembly operatively coupled tothe trigger, the inner shaft member, and the outer tubular member.

The actuation assembly as disclosed herein is configured to displace theouter tubular member in the proximal direction a distance (d) relativeto the handle and to separately move the inner shaft member distally adistance (x) relative to the handle upon deployment of the trigger froma first position to a second position, and further the actuationassembly is configured to move the inner shaft member proximally adistance (y) relative to the handle with no displacement of the outertubular member relative to the handle upon return of the trigger fromthe second position to the first position.

As embodied herein, the actuation assembly can be functionally coupledto the trigger by a driving rack. The trigger can include a slide havingan engagement surface to be engaged by the user. The slide can befixedly coupled to the driving rack.

The trigger of the disclosed subject matter can be functionallyconnected to the driving rack by a gear train. The gear train caninclude a trigger gear sector, a trigger pinion operatively meshed withthe trigger gear sector, a slide pinion operatively coupled to thetrigger pinion, and a slid rack disposed on a slide coupled to thedriving rack and operatively meshed with the trigger pinion. The drivingrack can be fixedly coupled to the slide. The driving rack can bedetachably coupled to the slide.

Alternatively, or additionally, the trigger can be functionallyconnected to the driving rack by one or more link elements. For example,a plurality of link elements can be provided. The plurality of linkelements can include a first linear link coupled to the trigger at afirst joint, a second linear link coupled to the slide at a secondjoint, and a triangle link coupled to the first linear link at a thirdjoint and the second linear link at a fourth joint. The triangle linkcan be coupled to the handle at a fifth joint, and the trigger can becoupled to the handle at a sixth joint. Each of the first, second,third, fourth, fifth, and sixth joints can be pivot joints. The thirdjoint, fourth joint, and fifth joint thus can define a triangle. Upondeployment of the trigger from the first position to the second positionand return of the trigger from the second position to the firstposition, the third joint can trace a non-linear path. Alternatively,the trigger can be functionally connected to the driving rack by atrigger pulley system.

Furthermore, the system can include a ratchet mechanism functionallycoupled to the trigger. The ratchet mechanism can include a first stateconfigured to allow the trigger to move toward the second position andprohibit motion toward the first position. The ratchet mechanism caninclude a second state configured to allow the trigger to move towardthe first position and prohibit motion toward the second position. Asembodied herein, the ratchet mechanism can include a first pawl and atrigger ratchet rack configured to engage the pawl to permitunidirectional motion of the slide. The pawl can include a first statewherein the pawl engages the trigger ratchet rack to permitunidirectional motion of the slide in a first direction. The pawl caninclude a second state wherein the pawl engages the trigger ratchet rackto permit unidirectional motion of the slide in a second direction. Thepawl can be configured to switch from the first state to the secondstate as the trigger approaches the second position from the firstposition. The pawl can be configured to switch from the second state tothe first state as the trigger approaches the first position from thesecond position. The pawl can be configured to be disengaged with thetrigger ratchet rack by urging the pawl away from the trigger ratchetrack. The pawl can be biased toward engagement with the trigger ratchetrack.

Additionally, the ratchet mechanism can include a second pawl having afirst state wherein the second pawl engages the ratchet rack to permitunidirectional motion of the slide in a second direction. The first andsecond pawl can each have a second state wherein the first and secondpawl do not engage the trigger ratchet rack, particularly when the otherpawl is in engagement. In this manner when the first pawl is in thefirst state the second pawl can be in the second state and when thesecond pawl is in the first state the first pawl can be in the secondstate. The ratchet mechanism can also include a ratchet trip coupled tothe first and second pawls. As the trigger approaches the secondposition from the first position the ratchet trip can cause the firstpawl to switch from the first state to the second state and the ratchettrip can cause the second pawl to switch from the second state to thefirst state. As the trigger approaches the first position from thesecond position the ratchet trip can cause the first pawl to switch fromthe second state to the first state and the ratchet trip can cause thesecond pawl to switch from the first state to the second state.

As disclosed herein, the trigger can be coupled to a spring such thatenergy is stored in the spring upon deployment of the trigger from thefirst position to the second position, and the energy stored in thespring causes the trigger to return from the second position to thefirst position. The system can include a spring support coupled to thetrigger and a base and configured to engage the spring such that energyis stored in the spring when the trigger is in the first position.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and are intended toprovide further explanation of the disclosed subject matter claimed.

The accompanying drawings, which are incorporated in and constitute partof this specification, are included to illustrate and provide a furtherunderstanding of the disclosed subject matter. Together with thedescription, the drawings serve to explain the principles of thedisclosed subject matter.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a perspective view of an exemplary embodiment of a deliverysystem in accordance with the disclosed subject matter.

FIG. 2 is a right side view, with a portion of the handle housingremoved, of the delivery system of FIG. 1.

FIG. 3 is a left side view, with a portion of the handle housingremoved, of the delivery system of FIG. 1.

FIG. 4 provides a top perspective view of selected elements of thetrigger assembly of the delivery system of FIG. 1.

FIGS. 5A-5D provide perspective FIG. 5A, right FIG. 5B, left FIG. 5C,and front FIG. 5D views of the trigger of the delivery system of FIG. 1.

FIGS. 6A-6D provide perspective FIG. 6A, right FIG. 6B, left FIG. 6C,and front FIG. 6D views of the trigger pinion of the delivery system ofFIG. 1.

FIGS. 7A-7D provide perspective FIG. 7A, right FIG. 7B, left FIG. 7C,and front FIG. 7D views of the slide pinion of the delivery system ofFIG. 1.

FIGS. 8A-8D provide perspective FIG. 8A, right FIG. 8B, left FIG. 8C,and front FIG. 8D views of the slide of the delivery system of FIG. 1.

FIGS. 9A-9D provide perspective FIG. 9A, right FIG. 9B, left FIG. 9C,and front FIG. 9D views of the base of the delivery system of FIG. 1.

FIG. 10 is a perspective view illustrating the relationship betweenselected elements of the delivery system of FIG. 1.

FIG. 11 provides a perspective view of the spring of the delivery systemof FIG. 1.

FIGS. 12A-12C are various views depicting the spring support of thedelivery system of FIG. 1.

FIGS. 13A-13D are various views depicting selected elements and therelationship between selected elements of the ratchet mechanism of thedelivery system of FIG. 1.

FIG. 14 is a perspective view of another exemplary embodiment of adelivery system in accordance with the disclosed subject matter.

FIG. 15 is a right side view, with a portion of the handle housingremoved, of the delivery system of FIG. 14.

FIG. 16 is a left side view, with a portion of the handle housingremoved, of the delivery system of FIG. 14.

FIGS. 17A-17D provide various views of selected elements and therelationship between selected elements of the ratchet mechanism of thedelivery system of FIG. 14.

FIG. 18 is a perspective view of yet another exemplary embodiment of adelivery system in accordance with the disclosed subject matter.

FIG. 19 is a right side view, with a portion of the handle housingremoved, of the delivery system of FIG. 18.

FIG. 20 is a left side view, with a portion of the handle housingremoved, of the delivery system of FIG. 18.

FIG. 21 is an exploded view of another exemplary embodiment of adelivery system in accordance with the disclosed subject matter.

FIG. 22 is a perspective view of a yet another exemplary embodiment of adelivery system in accordance with the disclosed subject matter.

FIG. 23 is a right side view, with a portion of the handle housingremoved, of the delivery system of FIG. 22.

FIG. 24 is a left side view, with a portion of the handle housingremoved, of the delivery system of FIG. 22.

FIG. 25 is a perspective view of another exemplary embodiment of adelivery system in accordance with the disclosed subject matter.

FIG. 26 is a right side view, with a portion of the handle housingremoved, of the delivery system of FIG. 25.

FIG. 27 is a left side view, with a portion of the handle housingremoved, of the delivery system of FIG. 25.

DETAILED DESCRIPTION

Reference will now be made in detail to the various exemplaryembodiments of the disclosed subject matter, exemplary embodiments ofwhich are illustrated in the accompanying drawings. The structure andcorresponding method of making and using the disclosed subject matterwill be described in conjunction with the detailed description of thedelivery system. The methods and systems described herein can be usedfor delivering a medical device, such as a stent, scaffold stent graft,valve, filter, or other suitable implant to a desired location in apatient.

Generally, and as set forth in greater detail, the disclosure subjectmatter provided herein includes a delivery system having a handle, atrigger, and an actuation assembly. The trigger is operatively coupledto the handle. The actuation assembly is operatively coupled to thetrigger, the inner shaft member, and the outer tubular member. As usedherein the terms “functionally” and “operatively” as used with“coupled,” “engaged,” or “connected,” are interchangeable and understoodby one of skill in the art. The actuation assembly is configured todisplace the outer tubular member in the proximal direction a distance(d) relative to the handle and to separately move the inner shaft memberdistally a distance (x) relative to the handle upon deployment of thetrigger from a first position to a second position, and further whereinthe actuation assembly is configured to move the inner shaft memberproximally a distance (y) relative to the handle with no displacement ofthe outer tubular member relative to the handle upon return of thetrigger from the second position to the first position.

In accordance with the described subject matter, a trigger assembly fora delivery system is also provided. The trigger assembly includes atrigger functionally connected to the actuation assembly by a drivingrack, a gear train functionally disposed between the trigger and thedriving rack. The gear train includes a trigger gear sector, a triggerpinion operatively meshed with the trigger gear sector, a slide pinionoperatively coupled to the trigger pinion, and a slide rack disposed ona slide coupled to the driving rack and operatively meshed with thetrigger pinion.

A variety of types of medical devices are suitable for delivery by thedelivery system of the present invention. For purpose of illustrationand not limitation, the delivery system is described herein with amedical device depicted as a self-expanding stent. Particularly,although not by limitation, reference is made herein to the implantbeing a braided stent or scaffold for purpose of illustration only.However, the delivery system presently disclosed is not limited to thedelivery of self-expanding stents. Other devices can also be used. Forexample, scaffolds, coils, filters, stent grafts, embolic protectiondevices, and artificial valves can be delivered within a patient'svasculature, heart, or other organs and body lumens using the discloseddelivery system. Other devices such as a prosthesis retrieval mechanismcan also be delivered with the delivery system to a predeterminedlocation in a patient's luminal system. Moreover, a combination ofmedical devices and/or beneficial agents can also be delivered using thedisclosed subject matter. For example, multiple stents and/or acombination of stents and embolic protection devices and/or beneficialagents can be delivered by the disclosed subject matter, as describedbelow. Additional information related to delivery of implants can befound in U.S. application Ser. No. 11/876,764, filed on Oct. 22, 2007,and U.S. application Ser. No. 13/118,325, filed on May 27, 2011, each ofwhich is incorporated by reference in its entirety herein.

Referring to FIG. 1 for the purpose of illustration and not limitation,various embodiments of the delivery systems disclosed herein generallycan include a handle 1, an outer tubular member 22, and an inner shaftmember 21. An implant 23, for example, a braided implant can be providedwith the system or independently. The handle can include a triggerassembly including a trigger 60 movable between and first position and asecond position, and an actuation assembly 2 (see e.g., FIG. 3)operatively coupled to the trigger 60. The outer tubular member 22 caninclude a proximal end portion and a distal end portion. The outertubular member 22 can be operatively coupled to the actuation assembly 2and can be movable in a proximal direction relative to the handle 1. Astabilizer tube (not shown) can be disposed over at least the proximalend portion of the outer tubular member 22, and a strain relief 15 canbe used to couple the stabilizer tube and the handle 1. The inner shaftmember 21 can include a proximal end portion and a distal end portion.The inner shaft member 21 can be disposed within the outer tubularmember 22 and can be operatively coupled to the actuation assembly 2.The inner shaft member 21 of the disclosed delivery system is movabledistally and proximally relative to the outer tubular member 22. Theimplant 23 can be disposed within the distal end portion of the outertubular member 22 and can be positioned to be engaged by the distal endportion of the inner shaft member 21 when the inner shaft member ismoved distally relative to the outer tubular member 22. The distal endportion of the inner shaft member 21 can have a pushing mechanismdisposed thereon. For example, U.S. application Ser. No. 13/118,325,filed on May 27, 2011, which is incorporated by reference in itsentirety herein, discloses suitable pusher elements for the deliverysystem. The outer tubular member 22 is depicted with a break in FIG. 1to indicate that the length shown is only exemplary and the outertubular member 22 and inner shaft member 21 can be longer than shown.Indeed, any suitable length can be used. As an example and not by way oflimitation, the outer tubular member 22 and inner shaft member 21 can belong enough to extend from outside the body of a patient through atortuous path to a treatment location within the body of a patient. Thehandle 1 can further include a luer lock at the proximal end of thehandle to receive a guidewire therethrough which can extend through theinner shaft member and/or a flushing device as desired.

The actuation assembly 2 of the disclosed subject matter is configuredto displace the outer tubular member 22 in the proximal direction adistance (d) relative to the handle 1 and to separately move the innershaft member 21 distally a distance (x) relative to the handle 1 upondeployment of the trigger 60 from the first position to the secondposition. Furthermore, the actuation assembly 2 is configured to movethe inner shaft member 21 proximally a distance (y) relative to thehandle 1 with no displacement of the outer tubular member 22 relative tothe handle 1 upon return of the trigger 60 from the second position tothe first position. Put another way, the actuation assembly 2 can beconfigured to move the outer tubular member 22 in a proximal directionrelative to the handle 1 and to separately move the inner shaft member21 distally relative to the outer tubular member 22 upon deployment ofthe trigger 60 form the first position to the second position. Theactuation assembly 2 can further be configured to move the inner shaftmember 21 proximally relative to the outer tubular member 22 with nodisplacement of the outer tubular member 22 relative to the handle 1upon return of the trigger 60 from the second position to the firstposition. Repeatedly deploying the trigger 60 from the first position tothe second position and returning the trigger from the second positionto the first position can cause the inner shaft member 21 to urge theimplant 23 from the outer tubular member 22.

The distance (y) minus the distance (x) can be substantially equal tothe distance (d). Upon deployment of the trigger 60 from the firstposition to the second position and return of the trigger 60 from thesecond position to the first position a net displacement of the innershaft member 21 relative to the outer tubular member 22 thus can bezero. The implant 23 can have a length, and the length of the implant 23can be less than the distance (x). Example lengths of the implant 23,for purpose of illustration and not limitation, can be 20 mm, 30 mm, 40mm, 60 mm, 80 mm, 100 mm, 120 mm, and 150 mm.

The distances (d), (x) and (y) can be selected based at least in part onthe diameter of the implant to be delivered, the desired compression ofthe implant to be delivered, the path between the insertion point andthe location of implant delivery, and/or other variables. As an example,and not by way of limitation, for a stent having a diameter of 4.5 mmwhen delivered to the vasculature, (d) can be about 12 mm, (x) can beabout 28 mm, and (y) can be about 40 mm. As another example and not byway of limitation, the ratio (referred to herein as the “gear ratio”)between the net distal motion of the inner shaft member 21 relative tothe outer shaft member 22 (i.e., the distance (d) plus the distance (x))to the distance (d) can be greater than 3. As an example, the gear ratioof (12+28):(12) is about 3.3. The actuation assembly disclosed hereinhaving such a gear ratio can be used to properly deploy a braided stentfrom an extended delivery configuration to an expanded deployedconfiguration and address a 3:1 change in length of the stent from thedelivery length to the deployment length. Exemplary diameters for stentswhen delivered to the vasculature can range from 4 mm to 12 mm orgreater, such as, exemplary diameters can be 4.5 mm, 5.0 mm, 5.5 mm, 6.0mm, 6.5 mm, 7.5 mm, or 8 mm, or suitable increments therebetween.

With regard to the trigger assembly, and for the purpose ofillustration, and not limitation, an exemplary embodiment of a systemfor delivering an implant is shown in FIG. 1 and is designated generallyby reference character 1000. Portions of this exemplary embodiment aredepicted in FIGS. 2-13. The handle 1 can include a first handle housingportion 1 a and a second handle housing portion 1 b. The system can alsoinclude a trigger 60. The trigger 60 is operatively coupled to thehandle and moveable between a first position and a second position.Furthermore the trigger can be biased towards the first and/or secondposition, for example, by a spring 91 (FIG. 11). As described in furtherdetail below, the trigger assembly can further include a ratchetmechanism 80 which can prevent moving the trigger between the first andsecond positions. Particularly, the ratchet can be configured to requirea full stroke of the trigger in one direction to allow motion of thetrigger in the opposite direction. Additionally, the trigger can includea trigger stop 67. The trigger stop 67 can be disposed between thetrigger 60 and the handle 1, and can limit how far the trigger 60 can beactuated. The size of trigger stop 67 can be selected based at least inpart on the diameter of the stent to be delivered, the desiredcompression of the stent to be delivered, the path between the insertionpoint and the location of stent delivery, and/or other variables. Thesystem 1000 can also include an actuation assembly 2. A variety ofsuitable actuation assemblies that can be used in conjunction with thetrigger assembly disclosed herein are disclosed in U.S. patentapplication Ser. No. 14/932,848; U.S. patent application Ser. No.14/932,875; U.S. patent application Ser. No. 14/932,862; U.S. patentapplication Ser. No. 14/932,884, filed concurrently herewith, orotherwise known in the art. The actuation assembly 2 can be operativelycoupled to the trigger 60, the inner shaft member 21 and the outertubular member 22.

As embodied herein, and with reference to FIG. 2, the trigger 60 can becoupled to the actuation assembly 2 by a driving rack 12. For example,the trigger 60 can be functionally coupled to the driving rack by geartrain. The gear train can include a trigger gear sector 63 (FIG. 5), atrigger pinion 64 (FIG. 6), a slide pinion 65 (FIG. 7), a slide 61 (FIG.8; sometimes referred to as an intermediate element) having a slide rack66, and a base 81 that can support certain elements of the gear train(FIG. 9). The trigger 63 can be pivotally coupled to the base 81. Thetrigger gear sector 63 can be coupled to the trigger 60, for example,the trigger gear sector 63 can be unitary with the trigger 60, and canbe operatively meshed with the trigger pinion 64. The trigger pinion 64can be operatively coupled to the slide pinion 65. For example, thetrigger pinion 64 and the slide pinion 65 can be coupled by splines andgrooves, such as, four splines on the trigger pinion 64 configured to bereceived by four grooves in the slide pinion 65 as depicted in FIGS. 6and 7. The slide pinion 65 can be operatively meshed with the slide rack66 disposed on the slide 61. The driving rack 12 can be coupled to theslide 61. The driving rack 12 can be fixedly coupled or releasablycoupled to the slide 61. As an example and not by way of limitation, thedriving rack 12 can have a bayonet-type engagement with the slide 61.Furthermore, more than one trigger gear sector and/or trigger pinion canbe provided, as shown, for example, in FIGS. 1-4 and 9, the gear traincan include two trigger gear sectors 63 and two trigger pinions 64. Eachof the trigger pinions 64 can be coupled to the slide pinion 65 asdescribed above.

As embodied herein, the slide pinion 65 can be quad symmetrical. Forexample, the slide pinion 65 can have 28 teeth evenly distributed insets of 7. The number of grooves can be a factor of the number of teeth,for example, 4 grooves and 28 teeth. Such a configuration can allow forsymmetry between the teeth and the grooves of the slide pinion 65, andthus ease of assembly and/or use. Accordingly, when the slide pinion 65is coupled the trigger pinion 64, the teeth are in proper alignment.Additionally or alternatively, the slide pinion 65 can include teetharound only a portion of the circumference. For example, rather thanincluding teeth about the entire circumference, a number of teeth (e.g.,10 teeth) can be removed or omitted. This arrangement can accommodateother elements, for example, the movement of spring 90 (described ingreater detail below) toward the slide pinion 65 during movement of thetrigger 60 when space is restricted. Furthermore, at least one splinecan be configured to align radially a selected location, e.g., a missingtooth, so as to allow for self-alignment.

With reference to FIGS. 11 and 12, for the purpose of illustration andlimitation, a spring 90 can be provided. The spring can be, for example,a torsion spring 90. Additional springs can likewise be provided, e.g.,two springs 90, as depicted in FIG. 4. The spring 90 can be coupled tothe trigger such that energy is stored in the spring 90 upon deploymentof the trigger 60 from the first position to the second position. Theenergy stored in the spring 90 thus can be configured to bias thetrigger 60 to return from the second position to the first position. Thespring 90 can be housed within a spring support 91 (FIG. 12). The springsupport can be coupled to the trigger 60 and the base 81. The springsupport 91 can house the spring 90 such that energy is stored in thespring 90 when the trigger 60 is in the first position, e.g., the springsupport 91 can hold the spring 90 in a pre-loaded position. Such aconfiguration can cause a force to be felt as the user initially beginsto move the trigger 60 from the first position to the second position.Additionally, by providing such a configuration, the spring can provideadditional force or bias to assist in returning the trigger 60 from thesecond position to the first position, and thus ensure that the trigger60 returns from the second position to the first position.

The spring support 90 can be configured to house and/or strengthen thespring, such as an exoskeleton arrangement. For example, the springsupport 90 can have legs configured to engage the legs of the torsionspring 90, as depicted in FIG. 12. The legs of the spring support 91 canbe configured to move with the legs of the torsion spring 90. If thespring includes a barrel portion, the spring support 91 can also includea barrel portion to accommodate the barrel portion of the spring 90. Thespring support 91 can be a single piece element, or can include severalelements coupled together to form the spring support (FIG. 12C). Theelements when assembled thus can be configured to allow the springsupport to move with the spring 90, but prevent the spring from fullyrelaxing. The spring support 91 thus can reduce or prevent loads onother elements of the delivery system, for example, the trigger 60 andthe base 81, which can be plastic. That is, the spring support 91 can bemade from metal or other suitably strong materials, preferably suchmaterials that are not susceptible to creep under stress.

In accordance with another aspect of the disclosed subject matter, thedelivery system can include a ratchet mechanism. With reference to FIG.13, for the purpose of illustration and not limitation, the system caninclude ratchet mechanism 80. The ratchet mechanism 80 can include afirst state and a second state. The first state can be configured toallow the trigger 60 to move toward the second position and prohibitmotion toward the first position. The second state can be configured toallow the trigger 60 to move toward the first position and prohibitmotion toward the second position. Such a system thus can be configuredto require the user to perform a full stroke of the trigger 60 betweenthe first and second position before allowing return movement in theopposite direction.

The ratchet mechanism 80 can include a first pawl 82. The first pawl 82can be supported by a peg 86 coupled to the base 81. The first pawl 82can pivot relative the peg, and thus relative the base 81. The firstpawl 82 can also be coupled to one end of a ratchet spring 87 (not shownfor purpose of clarity), which can be coupled to the base 81 at itsopposite end. The ratchet mechanism 80 also can include a triggerratchet rack 83 and the like. The trigger ratchet rack 83 can bedisposed on the slide 61. The trigger ratchet rack 83 can be configuredto engage the first pawl 82 to permit unidirectional motion of the slide61. By limiting the slide 61 to unidirectional motion, the trigger canlikewise be limited to unidirectional motion (i.e., toward the firststate or toward the second state). The first pawl 82 can have a firststate configured to allow the trigger 60 to move toward the secondposition and prohibit motion toward the first position and a secondstate configured to allow the trigger 60 to move toward the firstposition and prohibit motion toward the second position. The ratchetspring 87 can keep the pawl 82 biased toward the first position or thesecond position, selectively. That is, the pawl 82 can be configured toswitch from the first state to the second state as the triggerapproaches the second position from the first position. Likewise, thepawl 82 can be configured to switch from the second state to the firststate as the trigger approaches the first position from the secondposition. For example and not by way of limitation, the trigger ratchetrack 83 can be configured to move past the first pawl 83, as the triggerapproaches either the first position or the second position,respectively, and thus allow the first pawl 82 to move freely to thealternate state due to the bias of ratchet spring 87. As describedherein, the pawl 83 can engage the ratchet rack 83 in both the firstposition and the second position. Additionally or alternatively, theratchet mechanism can be configured with more than one rack, for examplea dual rack, and the pawl 83 can engage a different rack in each state.The pawl 82 can be moved out of the first or second position to a thirdposition (e.g., a defeated position) in which the pawl 82 does notengage the trigger ratchet rack 83. As an example, the pawl 82 can bemoved to the defeated position by moving the pawl 83 perpendicular tothe trigger ratchet rack 83 along peg 86. The base 81 can include adefeat hole 81 a (FIG. 9c ), which can be aligned with the pawl 82 andcan be aligned with a similar defeat hole in the handle 1, such that thepawl 82 can be defeated by pushing an instrument through the defeatholes and urging the pawl 82 along the peg 86. Peg 86 can be configuredto prevent the pawl 82 from returning to the first or second positionsonce the pawl has been moved to the defeated position. For example andas shown in FIG. 13d , the peg 86 can have a variable diameter. The pawl82 can be disposed on the larger diameter in the first or secondposition, and can be disposed on the smaller diameter in the defeatedposition. Furthermore, a damper can be disposed on the pawl 82, forexample rubber, for reduced noise. The ratchet spring 87 can also bedampened.

For purpose of illustration, reference is now made to the operation ofthe system with the actuation assembly disclosed herein. In operation,the user can deploy the trigger 60 from the first position to the secondposition (referred to herein as the “first action”). The trigger cancause movement of the trigger gear sector 63. The trigger gear sector 63can be functionally meshed with the trigger pinion 64 and can causerotation of the trigger pinion 64. The trigger pinion 64 can beoperatively coupled to the slide pinion 65, and can cause rotation ofthe slide pinion 65. The slide pinion 65 can be functionally engagedwith the slide rack 66 and can cause the slide rack 66 to move distally.The slide rack 66 can be coupled to the driving rack 12, and the drivingrack 12 can also move distally. The driving rack 12 can be functionallycoupled to the actuation assembly, and can cause the inner shaft member21 to move distally relative to the handle, and the outer tubular memberto move proximally relative to the handle. Thus, during the firstaction, the inner shaft member 21 can move distally relative to thehandle 1 and the outer tubular member 22 can move proximally relative tothe handle 1. During the first action, the pawl 82 can be in the firststate and can be configured to allow the trigger 60 to move toward thesecond position and prohibit motion toward the first position. The pawl82 can be configured to switch from the first state to the second stateas the trigger approaches the second position from the first position.

Upon return of the trigger 60 from the second position to the firstposition (herein referred to as the “second action”), which can becaused, for example, by the energy stored in the spring 90, the triggercan cause movement of the trigger gear sector 63 in the oppositiondirection as the first action. The trigger gear sector 63 can causerotation of the trigger pinion 64. The trigger pinion 64 can causerotation of the slide pinion 65. The slide pinion 65 can cause the sliderack 66 to move proximally. The driving rack 12 can be functionallycoupled to the actuation assembly, and can cause the inner shaft member21 to move proximally relative to the handle, and the outer tubularmember 22 remain stationary relative to the handle. Thus, during thesecond action, the inner shaft member 21 moves proximally relative tothe handle 1 and the outer tubular member 22 is stationary relative tothe handle. During the second action, the pawl 82 can be in the secondstate and can be configured to allow the trigger 60 to move toward thefirst position and prohibit motion toward the second position. The pawl82 can be configured to switch from the second state to the first stateas the trigger approaches the first position from the second position.

In accordance with an alternative embodiment of the disclosed subjectmatter, a delivery system is provided wherein the trigger is coupled tothe driving rack by a plurality of link elements. Referring now to FIG.14 for the purpose of illustration and not limitation, an exemplaryembodiment of a system for delivering an implant is provided anddesignated generally by reference character 1001. Portions of thisexemplary embodiment are depicted in FIGS. 15-17. Elements that aresimilar to the previously described embodiment have been given likenumbers. The delivery system 1001 can be configured to deliver animplant in a similar manner as described herein above.

The delivery system 1001 can include a handle 101, an outer tubularmember 122, an inner shaft member 121, and an implant 123, for example,a braided implant. The handle 101 can include a trigger 160 and anactuation assembly 102, which can be configured to move the inner shaftmember 121 and the outer tubular member 122 relative to the handle 101as described above upon deployment of the trigger 160 from the firstposition to the second position and return from the second position tothe first position. The trigger 160 can include a lock as describedherein above.

With reference to the exemplary embodiment herein, the trigger 160 canbe coupled to the driving rack 112 by a plurality of link elements. Thelink elements can include a first and second linear links 171 and 172, atriangle link 173, and a slide 161. A base 181 can support the slide 161and can have a trigger ratchet rack 183 disposed thereon. The firstlinear link 171 can be coupled to the trigger 160 at a first joint 174.The second linear link can be coupled to the slide 161 at a second joint175. The triangle link 173 can be coupled to the first linear link 171at a third joint 176 and the second linear link 172 at a fourth joint177. The triangle link 173 can be coupled to the handle at a fifth joint178 and the trigger 160 can be coupled to the handle at a sixth joint179. Each of the first, second, third, fourth, fifth, and sixth joints(174-179) can be pivot joints. The third joint 176, fourth joint 177,and fifth joint 178 can define a triangle. The slide 161 can be coupledto the driving rack 112. The driving rack 112 can be fixedly coupled orreleasably coupled to the slide 161. As an example and not by way oflimitation, the driving rack 112 can have a bayonet-type engagement withthe slide 161 (sometimes referred to herein as an intermediate element).A spring (not shown), such as a constant force spring or tape measurespring, can be coupled to the slide 161 and configured to bias thetrigger 160 toward the first position. The spring can be supported inbase 181. In particular embodiments, the spring can be coupled to anysuitable link of the plurality of links to bias the trigger 160 towardthe first position.

With reference to FIG. 17, for the purpose of illustration and notlimitation, the system can also include a ratchet mechanism 180. Theratchet mechanism 180 can include a first state and a second state. Thefirst state can be configured to allow the trigger 160 to move towardthe second position and prohibit motion toward the first position. Thesecond state can be configured to allow the trigger 160 to move towardthe first position and prohibit motion toward the second position. Sucha system can be configured to require the user to perform a full strokeof the trigger 160 between the first and second position, such asdescribed above.

As embodied herein, for illustration and not limitation, the ratchetmechanism 180 can include a first pawl 182 as well as a second pawl 184.The first and second pawls 182 and 184 can be supported on the slide 161and can include a ratchet trip 185 disposed between the first and secondpawls 182 and 184. The first and second pawls 182 and 184 can each havea first state in which the pawls engage the trigger ratchet rack 183 topermit unidirectional motion of the slide. The first pawl 182 can allowmotion in a first direction and the second pawl 182 can allow motion ina second direction. The first and second pawls 182 and 184 can each havea second state wherein the first and second pawls 182 and 184 do notengage the trigger ratchet rack 183. That is, when the first pawl 182 isin the first state the second pawl 184 can be in the second state, andwhen the second pawl 184 is in the first state the first pawl 182 can bein the second state. As the trigger 160 approaches the second positionfrom the first position, the ratchet trip 185 can cause the first pawl182 to switch (or disengage) to from the first state to the second stateand the ratchet trip 185 can cause the second pawl 184 to switch (orengage) from the second state to the first state. Likewise, as thetrigger 160 approaches the first position from the second position, theratchet trip 185 can cause the first pawl 182 to switch (or engage) fromthe second state to the first state and the ratchet trip 185 can causethe second pawl 184 to switch (or disengage) from the first state to thesecond state. The system can be configured to ensure that the pawls arenot simultaneous in the first state. The first pawl 182 and the secondpawl 184 can each be in the second position at the same time to defeatthe ratchet mechanism 180. Furthermore, the pawls and springs can bedamped as described hereinabove.

In operation of this exemplary embodiment, the user can deploy thetrigger 160 from the first position to the second position (referred toherein as the “first action”). The trigger 160 can pivot at the sixthjoint 179 (clockwise in FIG. 15). The trigger 160 can pull on the firstlinear link 171, which can cause the triangle link 173 to pivot at fifthjoint 178 (counter clockwise in FIG. 15). The triangle link 173 can pullsecond linear link 172 proximally, which can pull slide 161, andtherefore driving rack 112, proximally. The driving rack 112 can befunctionally coupled to the actuation assembly, and can cause the innershaft member 121 to move distally relative to the handle, and the outertubular member 222 to move proximally relative to the handle. Thus,during the first action, the inner shaft member 121 can move distallyrelative to the handle 101 and the outer tubular member 122 can moveproximally relative to the handle 101. During the first action, thefirst pawl 182 can be in the first state and can be configured to allowthe trigger 160 to move toward the second position and prohibit motiontoward the first position. The second pawl 184 can be in the secondposition, and thus not engaged with the trigger ratchet rack 183. Firstand second pawls 182 and 184 can be configured to switch from the firststate to the second state and from the second state to the first state,respectively, as the trigger approaches the second position from thefirst position. The transition of each pawl can be timed such that eachpawl 182 and 184 is in the second state for a period of time before thesecond pawl 184 switches to the first state.

Upon return of the trigger 160 from the second position to the firstposition (herein referred to as the “second action”), which can becaused, for example, by the energy stored in the spring 190, the trigger160 can pivot at the sixth joint 179 (counter clockwise in FIG. 15). Thetrigger can push on the first linear link 171, which can cause thetriangle link 173 to pivot at fifth joint 178 (clockwise in FIG. 15).The triangle link 173 can push the second linear link 172 distally,which can push slide 161, and therefore driving rack 112, distally. Thedriving rack 112 can be functionally coupled to the actuation assembly,and can cause the inner shaft member 121 to move proximally relative tothe handle, and the outer tubular member 122 remain stationary relativeto the handle. Thus, during the second action, the inner shaft member121 moves proximally relative to the handle 101 and the outer tubularmember 122 is stationary relative to the handle. During the secondaction, the second pawl 184 can be in the first state and can beconfigured to allow the trigger 160 to move toward the first positionand prohibit motion toward the second position. The first pawl 182 canbe in the second position and thus not engaged with the trigger ratchetrack 183. First and second pawls 182 and 184 thus can be configured toswitch from the second state to the first state and from the first stateto the second state, respectively, as the trigger approaches the firstposition from the second position. Additionally or alternatively, thetransition of each pawl can be timed such that each pawl 182 and 184 isin the second state for a desired period of time before the first pawl182 switches to the first state.

As embodied herein, upon deployment of the trigger 160 from the firstposition to the second position and return of the trigger 160 from thesecond position to the first position, the third joint 176 can trace anon-linear path. Such non-linear motion can result in a variable forcerequired to move the trigger 160 between positions along the path of thetrigger 160.

In accordance with an alternative embodiment of the disclosed subjectmatter, a delivery system is provided wherein the trigger is coupled tothe driving rack by a trigger pulley system. Referring now to FIG. 18for the purpose of illustration and not limitation, an exemplaryembodiment of a system for delivering an implant is provided anddesignated generally by reference character 1002. Portions of thisexemplary embodiment are depicted in FIGS. 19 and 20. Elements that aresimilar to the previously described embodiment have been given likenumbers. The delivery system 1002 can be configured to deliver animplant in a similar manner as described herein above.

The delivery system 1002 can include a handle 201, an outer tubularmember 222, an inner shaft member 221, and an implant 223, for example,a braided implant. The handle 201 can include a trigger 260 and anactuation assembly 202, which can be configured to move the inner shaftmember 221 and the outer tubular member 222 relative to the handle 201as described above upon deployment of the trigger 260 from the firstposition to the second position and return from the second position tothe first position. The trigger 260 can include a lock as describedherein above.

The trigger 260 can be coupled to the driving rack 212 by a triggerpulley system. For example, the trigger 260 can be coupled to the handleat joint 279, which can be a pivot joint. The trigger 260 can be coupledto the slide 261 by a tether 288. The slide 261 can be coupled to thedriving rack 212. The driving rack 212 can be fixedly coupled orreleasably coupled to the slide 261. As an example and not by way oflimitation, the driving rack 212 can have a bayonet-type engagement withthe slide 261 (sometimes referred to herein as an intermediate element).Additionally, the slide can be coupled to a spring 290, for example, aconstant force spring. The spring 290 can bias the slide toward a distalposition and the trigger 260 in the first position. The spring can besupported in base 281. Additionally, the handle 201 can include a window289 (FIG. 18), which can be used to manually move the slide.

In operation, the user can deploy the trigger 260 from the firstposition to the second position (referred to herein as the “firstaction”). The trigger 260 can pivot at the joint 279 (clockwise in FIG.19). The tether 288 coupled to the trigger 260 and the slide 261 canpull the slide 261, and therefore the driving rack 212, proximally. Thedriving rack 212 can be functionally coupled to the actuation assembly,and can cause the inner shaft member 221 to move distally relative tothe handle, and the outer tubular member 222 to move proximally relativeto the handle. Thus, during the first action, the inner shaft member 221can move distally relative to the handle 201 and the outer tubularmember 222 can move proximally relative to the handle 201.

Upon return of the trigger 260 from the second position to the firstposition (herein referred to as the “second action”), which can becaused, for example, by the energy stored in the spring 290 pulling theslide 261 distally, the driving rack 212 can be moved distally. Thedriving rack 212 can be functionally coupled to the actuation assembly,and can cause the inner shaft member 221 to move proximally relative tothe handle, and the outer tubular member 222 remain stationary relativeto the handle. Thus, during the second action, the inner shaft member221 moves proximally relative to the handle 201 and the outer tubularmember 222 is stationary relative to the handle.

Referring now to FIG. 21 for the purpose of illustration and notlimitation, an exemplary embodiment of a system for delivering animplant is provided and designated generally by reference character1003. Elements that are similar to the previously described embodimenthave been given like numbers. The delivery system 1003 can be configuredto deliver an implant in a similar manner as described herein above.

The delivery system 1003 can include a handle 301, an outer tubularmember 322, an inner shaft member 321, and an implant 323, for example,a braided implant. The handle 301 can include a trigger 360 and anactuation assembly 302, which can be configured to move the inner shaftmember 321 and the outer tubular member 322 relative to the handle 301as described above upon deployment of the trigger 360 from the firstposition to the second position and return from the second position tothe first position. The trigger 360 can include a lock as describedherein above.

The trigger 360 can include a slide 361 that can include an engagementsurface 362 to be engaged by the user. The driving rack 312 can befixedly coupled or releasably coupled to the slide 361. As an exampleand not by way of limitation, the driving rack 312 and the slide 361 canbe a unitary member. The trigger 360 can be coupled to a spring, whichcan bias the trigger 360 toward the first position.

During operation, the user can deploy the trigger 360 from the firstposition to the second position (referred to herein as the “firstaction”). The trigger, and therefore the slide 361 and the driving rack312, can move in a proximal direction. The driving rack 312 can befunctionally coupled to the actuation assembly, and can cause the innershaft member 321 to move distally relative to the handle, and the outertubular member 322 to move proximally relative to the handle. Thus,during the first action, the inner shaft member 321 can move distallyrelative to the handle 301 and the outer tubular member 322 can moveproximally relative to the handle 301.

Upon return of the trigger 360 from the second position to the firstposition (hereinafter referred to as the “second action”), the trigger360, and therefore the slide 361 and the driving rack 312 can move in adistally relative to the handle 301. The driving rack 312 can befunctionally coupled to the actuation assembly, and can cause the innershaft member 321 to move proximally relative to the handle, and theouter tubular member 322 remain stationary relative to the handle. Thus,during the second action, the inner shaft member 321 moves proximallyrelative to the handle 301 and the outer tubular member 322 isstationary relative to the handle.

Referring now to FIG. 22 for the purpose of illustration and notlimitation, an exemplary embodiment of a system for delivering animplant is provided and designated generally by reference character1004. Portions of this exemplary embodiment are depicted in FIGS. 23 and24. Elements that are similar to the previously described embodimenthave been given like numbers. The delivery system 1004 can be configuredto deliver an implant in a similar manner as described herein above.

The delivery system 1004 can include a handle 401, an outer tubularmember 422, an inner shaft member 421, and an implant 423, for example,a braided implant. The handle 401 can include a trigger 460 and anactuation assembly 402, which can be configured to move the inner shaftmember 421 and the outer tubular member 422 relative to the handle 401as described above upon deployment of the trigger 460 from the firstposition to the second position and return from the second position tothe first position. The trigger 460 can include a lock as describedherein above.

The trigger 460 can include a slide 461 that can include an engagementsurface 462 to be engaged by the user. The driving rack 412 can befixedly coupled or releasably coupled to the slide 461. As an exampleand not by way of limitation, the driving rack 412 and the slide 461 canbe a unitary member. The trigger 460 can be coupled to a spring, whichcan bias the trigger 460 toward the first position.

During operation, the user can deploy the trigger 460 from the firstposition to the second position (referred to herein as the “firstaction”). The trigger, and therefore the slide 461 and the driving rack412, can move in a distal direction. The driving rack 412 can befunctionally coupled to the actuation assembly, and can cause the innershaft member 421 to move distally relative to the handle, and the outertubular member 422 to move proximally relative to the handle. Thus,during the first action, the inner shaft member 421 can move distallyrelative to the handle 301 and the outer tubular member 422 can moveproximally relative to the handle 401.

Upon return of the trigger 460 from the second position to the firstposition (herein referred to as the “second action”), the trigger 460,and therefore the slide 461 and the driving rack 412 can move in aproximal relative to the handle 401. The driving rack 412 can befunctionally coupled to the actuation assembly, and can cause the innershaft member 421 to move proximally relative to the handle, and theouter tubular member 422 remain stationary relative to the handle. Thus,during the second action, the inner shaft member 421 moves proximallyrelative to the handle 401 and the outer tubular member 422 isstationary relative to the handle.

Referring now to FIG. 25 for the purpose of illustration and notlimitation, an exemplary embodiment of a system for delivering animplant is provided and designated generally by reference character1005. Portions of this exemplary embodiment are depicted in FIGS. 26 and27. Elements that are similar to the previously described embodimenthave been given like numbers. The delivery system 1005 can be configuredto deliver an implant in a similar manner as described herein above.

The delivery system 1005 can include a handle 501, an outer tubularmember 522, an inner shaft member 521, and an implant 523, for example,a braided implant. The handle 501 can include a trigger 560 and anactuation assembly 502, which can be configured to move the inner shaftmember 521 and the outer tubular member 522 relative to the handle 501as described above upon deployment of the trigger 560 from the firstposition to the second position and return from the second position tothe first position. The trigger 560 can include a lock as describedherein above.

The trigger 560 can include a slide 561 that can include an engagementsurface 562 to be engaged by the user. The driving rack 512 can befixedly coupled or releasably coupled to the slide 561. As an exampleand not by way of limitation, the driving rack 512 and the slide 561 canbe a unitary member. The trigger 560 can be coupled to a spring, whichcan bias the trigger 560 toward the first position.

During operation, the user can deploy the trigger 560 from the firstposition to the second position (referred to herein as the “firstaction”). The trigger, and therefore the slide 561 and the driving rack512, can move in a distal direction. The driving rack 512 can befunctionally coupled to the actuation assembly, and can cause the innershaft member 521 to move distally relative to the handle, and the outertubular member 522 to move proximally relative to the handle. Thus,during the first action, the inner shaft member 521 can move distallyrelative to the handle 501 and the outer tubular member 522 can moveproximally relative to the handle 501.

Upon return of the trigger 560 from the second position to the firstposition (herein referred to as the “second action”), the trigger 560,and therefore the slide 561 and the driving rack 512 can move in aproximal relative to the handle 501. The driving rack 512 can befunctionally coupled to the actuation assembly, and can cause the innershaft member 521 to move proximally relative to the handle, and theouter tubular member 522 remain stationary relative to the handle. Thus,during the second action, the inner shaft member 521 moves proximallyrelative to the handle 501 and the outer tubular member 522 isstationary relative to the handle.

The embodiments described above can be formed of any suitable materials,for example, the handle and actuation assembly elements can be made fromplastic, composites, or metal. The handle housing portion can be madefrom glass filled plastics or other plastic resins, for example ADS,polycarbonate, or an ADS polycarbonate blend. A rubber overmold can beused for grip and aesthetics, for example, on the trigger and the handlebody. The strain relief can be a soft plastic, for example,polyethylene. The trigger and related elements can be formed by siliconimpregnated poly oxymethylene or acetal (e.g., DelRin® sold by DuPont).The various pins and springs can be formed from plastic, metal (e.g.,stainless steel or aluminum), or music wire. Spring dampers can be madeof UNA, EPVM, Silicon, Eurothane, or Santoprene.

While the disclosed subject matter is described herein in terms ofcertain preferred embodiments for purpose of illustration and notlimitation, those skilled in the art will recognize that variousmodifications and improvements can be made to the disclosed subjectmatter without departing from the scope thereof. Moreover, althoughindividual features of one embodiment of the disclosed subject mattercan be discussed herein or shown in the drawings of one embodiment andnot in other embodiments, it should be readily apparent that individualfeatures of one embodiment can be combined with one or more features ofanother embodiment or features from a plurality of embodiments.

In addition to the specific embodiments claimed below, the disclosedsubject matter is also directed to other embodiments having any otherpossible combination of the dependent features claimed below and thosedisclosed above. As such, the particular features presented in thedependent claims and disclosed above can be combined with each other inother possible combinations. Thus, the foregoing description of specificembodiments of the disclosed subject matter has been presented forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosed subject matter to those embodimentsdisclosed.

The following applications, which are filed on the same day as thisapplication, are incorporated by reference in their entirety: U.S.patent application Ser. No. 14/932,848; U.S. patent application Ser. No.14/932,875; U.S. patent application Ser. No. 14/932,862; U.S. patentapplication Ser. No. 14/932,884; U.S. patent application Ser. No.14/932,805; U.S. patent application Ser. No. 14/932,830; U.S. patentapplication Ser. No. 14/932,900; PCT Patent Application No.PCT/US2015/059070; PCT Patent Application No. PCT/US2015/059074; and PCTPatent Application No. PCT/US2015/059084.

Furthermore, it is recognized that the actuation assembly and deliverysystem as disclosed herein can be used in a method of delivering animplant. That is, for purpose of illustration, such method would includeproviding a delivery system as disclosed herein, positioning the distalend portion of the outer tubular member proximate a desired site, anddeploying the delivery system to push the implant from the outer tubularmember to the desired site.

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the method and system of thedisclosed subject matter without departing from the spirit or scope ofthe disclosed subject matter. Thus, it is intended that the disclosedsubject matter include modifications and variations that are within thescope of the appended claims and their equivalents.

1. A system for delivering an implant, the implant to be disposed withina distal end portion of an outer tubular member and positioned to beengaged by a distal end portion of an inner shaft member when the innershaft member is moved distally relative to the outer tubular member, theinner shaft member being disposed within the outer tubular member andmovable distally and proximally relative to the outer tubular member,comprising: a handle; a trigger operatively coupled to the handle; andan actuation assembly operatively coupled to the trigger, the innershaft member, and the outer tubular member; wherein the actuationassembly is configured to displace the outer tubular member in theproximal direction a distance (d) relative to the handle and toseparately move the inner shaft member distally a distance (x) relativeto the handle upon deployment of the trigger from a first position to asecond position, and further wherein the actuation assembly isconfigured to move the inner shaft member proximally a distance (y)relative to the handle with no displacement of the outer tubular memberrelative to the handle upon return of the trigger from the secondposition to the first position.
 2. The system of claim 1, wherein theactuation assembly is functionally coupled to the trigger by a drivingrack.
 3. The system of claim 2, wherein the trigger comprises a slidehaving an engagement surface to be engaged by a user.
 4. The system ofclaim 3, wherein the slide is fixedly coupled to the driving rack. 5.The system of claim 2, wherein the trigger is functionally connected tothe driving rack by a gear train.
 6. The system of claim 5, wherein thegear train comprises a trigger gear sector, a trigger pinion operativelymeshed with the trigger gear sector, a slide pinion operatively coupledto the trigger pinion, and a slid rack disposed on a slide coupled tothe driving rack and operatively meshed with the trigger pinion.
 7. Thesystem of claim 6, wherein the driving rack is fixedly coupled to theslide.
 8. The system of claim 6, wherein the driving rack is detachablycoupled to the slide.
 9. The system of claim 2, wherein the trigger isfunctionally connected to the driving rack by a plurality of linkelements.
 10. The system of claim 9, wherein the plurality of linkelements comprises a first linear link coupled to the trigger at a firstjoint, a second linear link coupled to the slide at a second joint, anda triangle link coupled to the first linear link at a third joint andthe second linear link at a fourth joint; wherein the triangle link iscoupled to the handle at a fifth joint, and the trigger is coupled tothe handle at a sixth joint.
 11. The system of claim 10, wherein each ofthe first, second, third, fourth, fifth, and sixth joints are pivotjoints.
 12. The system of claim 10, wherein the third joint, fourthjoint, and fifth joint define a triangle.
 13. The system of claim 10,wherein upon deployment of the trigger from the first position to thesecond position and return of the trigger from the second position tothe first position, the third joint traces a non-linear path.
 14. Thesystem of claim 2, wherein the trigger is functionally connected to thedriving rack by a trigger pulley system.
 15. The system of claim 1,wherein the trigger is coupled to a spring such that energy is stored inthe spring upon deployment of the trigger from the first position to thesecond position, and the energy stored in the spring causes the triggerto return from the second position to the first position.
 16. The systemof claim 15, wherein the system further comprises a spring supportcoupled to the trigger and a base and configured to engage the springsuch that energy is stored in the spring when the trigger is in thefirst position.
 17. The system of claim 1, further comprising an implantdisposed within the distal end portion of an outer tubular member. 18.The system of claim 17, wherein the implant is a braided stent.